This can be a touchy subject for any post-menopausal woman. Claudia Mann gets frank about sex after menopause and ways you can feel good in bed again.

By Claudia Mann

Here’s how I found out. I was preoccupied with work and family, not paying attention to my own health. Finally, I went for a checkup and mentioned I hadn’t had a period in six months. I’d just turned 51, so it was no big mystery. Back came my blood work: so much for peri-, I was post-menopausal. Wow, game over. My next reaction was relief. No weight gain or mood swings, not one hot flash. I was Ms. Scot-Free, I thought, considering between five to 10 pounds of weight gain can be expected, more than a quarter of post-menopausal women reported depression over a previous two-week period and up to 80 per cent of menopausal women experience hot flashes. Experts say symptoms as minimal as mine aren’t abnormal, but they definitely rank as lucky. If it makes anyone feel any better, I did start getting up to pee twice a night – not a urine control problem (26 per cent) in my case, more so trouble sleeping (43 per cent).

With menopause to wrap my head around, romance was nowhere near my to-do list. My lacklustre attitude probably had something to do with my ex, a gentlemanly type. “It’s better for you if I don’t thrust,” he told me the first time we did It. I never summoned the gumption to tell him I needed some bang to go with the whispering. His prior partner was exactly my age; I guess she knew what I didn’t.

Tailored Shirts and I broke up. I went 16 months without so much as a wink. Then, last summer, I fell deep in crush and lust with a wonderful, vigorous man. By Date No. 4, he was dying to get me naked and vice versa. We were ready for a whole night of … ow, ow, OUCH. Who in God’s name had filled my lady parts with sand? Why did sex suddenly feel like death by a hundred paper cuts?

The answer is that I, like as many as 50 per cent of post-menopausal women, suffer from vulvovaginal atrophy (VVA), recently renamed as genitourinary syndrome of menopause (GSM). Without estrogen to keep your vaginal tissues robust and moist, sex, by which I mean good old friction-based intercourse, can cause itching, burning and pain. “The vaginal tissues dry up,” explains Dr. Susan Goldstein, a Toronto-based menopause practitioner certified by the North American Menopause Society (NAMS). “They get less elastic, thinner and more friable, which means they bleed more easily.” My year-and-a-half of abstinence did more than keep me in the dark – a woman my age needs to use it or lose it. “The more you have intercourse, the more you stimulate local blood circulation, which helps heal the tissues,” advises Goldstein when it comes to mitigating atrophy if not preventing it. Any stimulation is good, human or sex toy. (Take it from me: shower heads set to tepid may be great for multiples but, in retrospect, I should have gone ahead and lost my vibrator virginity.)

With three million women across Canada in menopause, I’m not alone. What else can we million-plus saddled with GSM do about it? “Lubricants during sex” is Goldstein’s first suggestion. “That can give symptom relief. The second step is a polycarbophil over-the-counter vaginal moisturizer you put into the vagina two or three times a week.” A typical example is Replens. “A lot of people think it’s lubricant, but it’s not,” Goldstein clarifies.

Personally, I tried the non-medical route, but my body and lube are enemies no matter how diligently I source water-soluble organics from feminist sex shops. No thank you to a yeast infection on top of everything else. Welcome to my life, Vagifem. For two straight weeks initially, then twice a week indefinitely, I insert a pill in a little blue plunger right where the action is. “Vaginal estrogen is a smaller dose [than oral hormone replacement therapy (HRT)] and locally applied, so you don’t have the risks that we see with breast cancer and other things,” Goldstein explains. What about my beloved? “There’s a short amount of contact and if he washes off afterwards, it’s almost zero,” Goldstein notes a recommendation from NAMS to dose at least 12 hours before coital activity to prevent estrogen absorption by a partner.

Let me put it this way: we’re happier. My knickers are less weirdly sterile than they were once my cycle ended, and my discomfort is 95 per cent reduced. “Putting estrogen in the vagina will heal and replenish the tissue so it will start to get thicker,” confirms Goldstein. “You won’t go back to zero but you’ll certainly be improved.”

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